Chi, N., Demiris, G., Lewis, F.M., Walker, A.J., & Langer, S.L. (2016). Behavioral and educational interventions to support family caregivers in end-of-life care. American Journal of Hospice and Palliative Medicine, 33, 894–908. 

DOI Link

Purpose

STUDY PURPOSE: To collect, review, and report on the current evidence on behavioral and educational interventions used to support family caregivers of patients who are receiving end-of-life care

TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: PubMed, CINAHL, Embase, Cochrane Library
 
INCLUSION CRITERIA: Phase II or phase III clinical trials published in English, looking at behavioral and educational interventions to support family caregivers at end-of-life care; published from 2004–2014
 
EXCLUSION CRITERIA: Peer review required, not caregiver focused, not family caregivers of adults receiving end-of-life care

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 2,649, 618 were in English
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The Oxford Center for Evidence-Based Medicine framework was used to evaluate the findings.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 14 
  • TOTAL PATIENTS INCLUDED IN REVIEW: 1,773 total—406 in educational interventions, 1,152 in cognitive behavioral therapy interventions, and 575 in psychoeducational interventions
  • SAMPLE RANGE ACROSS STUDIES: Three studies had a sample of 10–50, two had 50–100, five had more than 100, two had more than 200, one hand more than 300, and one had more than 400.
  • KEY SAMPLE CHARACTERISTICS: All studies were phase 2 or 3 studies. Eight of 14 studies included caregivers of patients with advanced cancer; mean age of 55–61 years; high percentage of females (70% in 10 studies), Caucasians (60%–80% in seven studies), and spouses/partners (60%–70% in six studies)

Phase of Care and Clinical Applications

PHASE OF CARE: End-of-life care
 
APPLICATIONS: Palliative care

Results

Fourteen studies were identified, eight of which involved patients with cancer, supporting the use of educational, psycho-educational, and cognitive behavioral interventions to support caregivers in end-of-life care. Cognitive behavioral therapy had the strongest evidence and impact on most outcomes, with six intervention studies reported on, five studying patients with advanced cancer, and four of which were randomized, controlled trials (three with samples more than 100). Outcomes included statistically significant improvement and increased self-efficacy, quality of life, hope, psychological health, and problem solving. Four psycho-educational intervention studies existed, all involving patients with advanced cancer. Two were large randomized, controlled trials, with samples of 100. Caregivers showed increased preparedness, competence, knowledge, improved psychological health, increased positive rewards, less unmet needs, and increased social support. The four educational interventions studied included two smaller studies and, although studying care of patients at the end of life, none of them were specific to patients with cancer, although some included patients with advanced cancer. One of the larger studies (n = 110) was of caregivers of patients with dementia. The interventions in these studies showed improvement in caregiver preparedness, knowledge, support, confidence, helpful beliefs, and satisfaction with care.

Conclusions

Educational and behavioral interventions for caregivers of patients with advanced cancer at the end of life appear to be effective. They are difficult to study because of high attrition rates, in part because of the point in the illness trajectory in which one is asked to participate. However, increasing evidence supports that these types of interventions will benefit caregiver competence and well-being. Ongoing study is needed to identify more specifics about the interventions, what makes them successful, and the methods of delivery, the timing, and the dose, as well as what outcomes should be measured and with what instruments. Perhaps some consistency should be developed. The cost-effectiveness of interventions should be considered as well.

Limitations

  • High heterogeneity
  • High attrition rates
  • About half were smaller studies of quasiexperimental design, and the types of interventions studied were clearly different and should be looked at individually.

Nursing Implications

Educational and behavioral interventions for caregivers appear to be helpful in improving caregiver outcomes, with statistical improvement seen in a variety of caregiver domains. The type of intervention strategy used seems to influence the specificity and breadth of outcomes influenced, with some showing more results on competence and knowledge and others expanding beyond competence and knowledge to include an additional impact on the emotional well-being and quality of life of the caregiver. All three types of interventions appear to have positive impact. Care must be taken when choosing an intervention, considering what outcome is desire.

Legacy ID

6432